This action might not be possible to undo. Are you sure you want to continue?
56 – © Australian Physiotherapy Association 2010 63
General description: The coping strategy questionnaire
(CSQ), (Rosenstiel & Keefe 1983) in its original version
consists of 50 items assessing patient self rated use of
cognitive and behavioural strategies to cope with pain. It
comprises six subscales for cognitive strategies (ignoring
pain, reinterpretation of pain, diverting attention, coping
self statements, catastrophising, praying/hoping) and two
subscales for behavioural strategies (increasing activity
levels and increasing pain behaviours). Each coping strategy
subscale consists of six items measured with a numerical
rating scale ranging from 0 (never do that) to 6 (always do
that) indicating how frequently the strategy is used to cope
with pain. Each subscale has a maximum score of 36 and a
minimum score of 0. An additional two single item questions
each with a scoring range of 0–6 are used as effectiveness
ratings of control over pain and ability to decrease pain.
The CSQ takes approximately 5 minutes to complete.
Reliability and validity: In a sample of 61 patients with
chronic low back pain (CLBP), Rosenstiel and Keefe
(1983) reported the internal consistency for the subscales
with Cronbach’s alphas ranging from 0.71 to 0.85, except
for the increasing pain behaviour subscale which had an
internal consistency of 0.28. However, in a sample of 282
CLBP patients, Jensen and Linton (1993) showed that all
8 subscales of the CSQ Swedish version have an internal
consistency ranging from 0.69 to 0.84. Similarly, in patients
with lung cancer, the CSQ subscales have shown good
internal consistency with Cronbach’s alphas ranging from
0.60 to 0.90 (Wilkie & Keefe 1991). Test-retest reliability
for a 1 day interval has been reported to range between
0.68 and 0.91 (Main & Waddell 1991), 0.48–0.71 for a 1
week interval and 0.58–0.84 for a 5 week interval (Jensen
& Linton 1993).
The Coping Strategy Questionnaire
Support exists for the construct validity of the CSQ in chronic
pain populations where signifcant correlations have been
shown with questionnaires measuring depression, anxiety,
self-effcacy and physical functioning (Lawson et al 1990,
Geisser et al 1994, Swartzman et al 1994, Burckhardt et al
Studies using factor analysis to investigate the underlying
dimensions of the 8 CSQ subscales and 2 effectiveness items
have frequently reported a three factor solution consisting
of 1) cognitive coping and suppression, 2) behavioural
activity, and 3) pain control/rational thinking (Rosenstiel &
Keefe 1983, Keefe & Dolan 1986, Lawson 1990, Geisser et
al 1994, Burckhardt et al 1997). Using exploratory factor
analysis on an individual item level, two studies obtained a
fve factor solution (Tuttle et al 1991, Swartzman et al 1994).
Recognising the small samples used in previous studies,
item level exploratory factor analysis was performed on the
CSQ from a large sample of 965 patients CLBP revealing a
six factor solution similar to the subscales originally derived
in the CSQ (Robinson et al 1997).
Riley and Robinson (1997) compared the fve and six factor
solutions for the CSQ using linear structural equation
modelling. From the results, Riley and Robinson (1997)
recommended a revision of the coping strategy questionnaire
(CSQ-R) retaining 27 items from the original CSQ. This
included all six items of the catastrophising subscale, fve
items from each of the ignoring pain and reinterpreting
pain sensations subscales, four items from coping self-
statements and diverting attention subscales, and three
items related to praying factors. In a recent study on patients
with cancer related pain, Utne et al (2009) also showed less
factorial variance in the CSQ-R than the original CSQ and
recommends the CSQ-R for use in clinical research.
Monitoring coping strategies is of clinical importance
as they have been shown to mediate the infuence of
pain intensity on functional disability and quality of life
(Abbott et al 2010) and to infuence the adjustment of pain
(Rosenstiel & Keefe 1983). The CSQ has been shown to
be valid for use in several different patient groups such
as osteoarthritis, knee replacement surgery, rheumatoid
arthritis, fbromyalgia, low back pain, lumbar spine surgery,
and even cancer-related pain.
The CSQ is a useful clinical tool for the screening of
coping styles. It provides information for patients and
clinicians on the effcacy of coping strategies and those
strategies needing addressing to help facilitate pain control
and mediate improvement of functional outcomes. Data on
the CSQ-R sensitivity of change is lacking. More research
using the CSQ-R is needed to improve the questionnaire’s
validity as an outcome measure and provide more extensive
Karolinska Institute, Sweden
Abbott AD (2010) Physiotherapy, in press.
Burckhardt CS et al (1997) J Muscoskel Pain 5: 5–21.
Geisser ME et al (1994) Clin J Pain 10: 98–106.
Jensen IB, Linton SJ (1993) Scand J Behav Ther 22: 139–145.
Keefe FJ, Dolan E (1986) Pain 24: 49–56.
Lawson K et al (1990) Pain 43: 195–204.
Main CJ, Waddell G (1991) Pain 46: 287–298.
Riley JL, Robinson ME (1997) Clin J Pain 13: 156–162.
Robinson et al (1997) Clin J Pain 13:43-49.
Rosenstiel AK, Keefe FJ (1983) Pain 17:33-44.
Swartzman LC et al (1994) Pain 57:311-316.
Turner JA et al (2000) Pain 15:115-125.
Tuttle DH et al (1991) Pain 36:179-188.
Utne I et al (2009) Clin J Pain 25:391-400.
Wilkie DJ, Keefe FJ (1991) Clin J Pain 7:29.